June 10, 2013

Children Suffering Second Concussion In Year Have Longer Recovery Time

Researchers writing in the journal Pediatrics say a child who has had more than one concussion could have a prolonged recovery.

The team said that kids who experienced a second concussion within a year of the first head injury suffered symptoms nearly three times longer than a child with a concussion that was spaced over a year prior. They studied 280 patients between the ages of 11 and 22 with a mean age of 14 who were treated in the emergency department (ED) for concussive symptoms.

The researchers hypothesized that symptoms for those with a previous concussion would take longer to clear than those without a history, and those who sustained a concussion within the previous year would have a longer time until symptom resolution than those whose injuries were more remote in time.

"Our study demonstrates this temporary sensitive effect of previous concussion for the first time in humans," said lead author Matthew A. Eisenberg, MD, of the Division of Emergency Medicine, Boston Children's Hospital. "This has direct implications on the management of athletes and other at-risk individuals who sustain concussions, supporting the concept that sufficient time to recover from a concussion may improve long-term outcomes."

He said their findings should help reduce "uncertainty among patients, families and health care providers as to which patients would benefit from specialist follow-up, extended academic accommodations, prolonged abstinence from athletic participation and even permanent cessation of high-risk activity."

They found that children and young adults who had just suffered their second concussion in the last year took an average of 35 days to get back to normal, compared to the typical 10- to 14-day recovery window.

Eisenberg said their findings gives parents and doctors more reason for caution when deciding how long a child should be kept out of sports or school after a head injury.

"Even after symptoms have improved and even after these neuropsychological tests have returned to normal, there's still a vulnerability that can lead to a much more severe second concussion," Dr. Matthew Eisenberg, from Boston Children's Hospital, told Reuters Health.

He said the next goal for the team is to look for something on a blood test, urine test or brain scan that will tell doctors when a child is back to normal from the concussion. According to a study published in the December 2012 issue of The Journal of Neuroscience, concussions affect children's brains even after symptoms subside.

“Further work is needed to determine whether the changes in white matter present at four months represent a prolonged recovery process or permanent change in the brain,” said Christopher Giza, MD, an expert on developmental brain injuries from the Mattel Children´s Hospital and the Brain Injury Research Center at the University of California, Los Angeles. “Determining the duration of the structural changes, and whether these changes have clinical implications, remain critical areas for future studies,” he said.